ITE Gastroenterology and Hepatology 2 — Questions and Answers
Question 1: A 58-year-old man with alcoholic cirrhosis develops confusion and asterixis. Ammonia level is elevated. Which treatment is most appropriate?
- Lactulose (Correct answer)
- Neomycin
- Rifaximin
- Zinc supplementation
Correct answer: Lactulose
Lactulose is first-line therapy for hepatic encephalopathy, reducing ammonia absorption by acidifying colonic contents and promoting excretion.
Question 2: A 45-year-old woman presents with jaundice, pruritus, and elevated alkaline phosphatase. AMA is positive. What is the most likely diagnosis?
- Primary sclerosing cholangitis
- Primary biliary cholangitis (Correct answer)
- Autoimmune hepatitis
- Choledocholithiasis
Correct answer: Primary biliary cholangitis
Anti-mitochondrial antibody (AMA) positivity with cholestatic pattern strongly suggests primary biliary cholangitis, a chronic autoimmune bile duct disease predominantly affecting middle-aged women.
Question 3: A patient with long-standing Crohn's disease develops right lower quadrant pain and fever. CT shows a 4 cm fluid collection adjacent to the terminal ileum. What is the best next step?
- IV antibiotics alone
- Emergent surgery
- Percutaneous drainage plus antibiotics (Correct answer)
- Colonoscopy
Correct answer: Percutaneous drainage plus antibiotics
A walled-off abscess in Crohn's disease is best managed with percutaneous drainage plus antibiotics, avoiding emergent surgery and allowing inflammation to subside before elective resection if needed.
Question 4: Which of the following is the most common cause of acute pancreatitis in the United States?
- Hypertriglyceridemia
- Gallstones (Correct answer)
- Alcohol
- Medications
Correct answer: Gallstones
Gallstones (biliary pancreatitis) account for approximately 40% of acute pancreatitis cases in the US, making it the most common etiology.
Question 5: A 62-year-old man undergoes colonoscopy showing a 1.5 cm sessile serrated lesion in the ascending colon. When should surveillance colonoscopy be performed?
- 1 year
- 3 years (Correct answer)
- 5 years
- 10 years
Correct answer: 3 years
Sessile serrated lesions ≥10 mm or with dysplasia warrant 3-year surveillance colonoscopy per current ACG guidelines due to their malignant potential.
Question 6: A 35-year-old woman with diarrhea, bloating, and weight loss has anti-tissue transglutaminase IgA antibodies. Duodenal biopsy shows villous atrophy and crypt hyperplasia. What is the first-line treatment?
- Mesalamine
- Prednisone
- Gluten-free diet (Correct answer)
- Azathioprine
Correct answer: Gluten-free diet
Celiac disease is treated with strict adherence to a gluten-free diet, which leads to mucosal healing and resolution of symptoms in the majority of patients.
Question 7: A patient with cirrhosis develops spontaneous bacterial peritonitis (SBP). After treatment, which prophylactic antibiotic is recommended to prevent recurrence?
- Cephalexin
- Norfloxacin (Correct answer)
- Metronidazole
- Amoxicillin-clavulanate
Correct answer: Norfloxacin
Norfloxacin (or trimethoprim-sulfamethoxazole as an alternative) is recommended for long-term secondary prophylaxis after a first episode of SBP to reduce recurrence risk.
ITE Gastroenterology and Hepatology 2
A 58-year-old man with alcoholic cirrhosis develops confusion and asterixis.
Ammonia level is elevated.
Which treatment is most appropriate?